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Good Friday Service Registration
SERVICE TIME: FRIDAY, APRIL 15, 10:00 AM
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Phone Number
*
Your answer
Number of total seats (including yourself)
1
2
3
4
5
6
7
8
Clear selection
Symptoms - Do you have any of the following new or worsening symptoms or sings?
Fever and/or chills
Cough or barking cough
Shortness of breath
Sore throat or trouble swallowing
Runny or stuffy nose
Decrease or loss of taste or smell
Pink eye
Headache
Very tired, sore muscles, or joints
Does anyone in your household have one or more of the above symptoms AND / OR are waiting for test results after experiencing symptoms?
*
Yes
No
In the last 14 days, have you travelled outside of Canada AND been advised to quarantine per federal quarantine requirements?
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Yes
No
In the last 14 days, have you been notified as a CLOSE CONTACT of someone with COVID-19 or been told to stay home and self-isolate?
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Yes
No
In the last 10 days, have you tested positive on a rapid antigen test or a home-based self-testing kit?
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Yes
No
In the last 14 days, have you received a COVID Alert exposure notification on your cell phone?
*
Yes
No
If you have answered YES to any of the above questions, or if you have any of the symptoms listed above, PLEASE DO NOT ENTER THE BUILDING
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I agree
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A copy of your responses will be emailed to the address you provided.
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